Rummel Review

Your Risks, Covered

A great opportunity to assess coverage.

There’s one guarantee in life and business. Things change. Our Rummel Review is an opportunity to compare your existing coverage against your current needs to ensure your insurance remains appropriate to your situation.

Complete Annual Rummel Review

Step 1 of 10

10%

Client Information

Primary Contact Name*

FirstLast

Primary Phone Number*

example: 555-555-1234

Primary Phone Number is:*

Home Phone

Cell Phone

Work Phone

Cell Phone Number

example: 555-555-1234

Work Phone Number

example: 555-555-1234

Primary Email Address*

Preferred Method of Contact*

Phone - Home

Phone - Cell

Phone - Work

Text Message

Email

What type(s) of insurance do you currently have with us?*

Personal Insurance

Business Insurance

Home Address*

Street AddressAddress Line 2CityStateZIP Code

Company Name*

Company Address*

Street AddressAddress Line 2CityStateZIP Code

Total Annual Sales*

Total Number of Employees*

Changes in Your Life:

Please think back over the last year when answering these questions.

Please list all who live at your address.

Have any children recently moved out, gone to college or changed residency?*

Yes

No

Have you had any lifestyle changes causing a name and/or address change?*

Yes

No

What is your current job status?*

Unemployed

Retired

Employed

If employed, name employer, occupation & employer's address.

Have you had a switch in occupation that would change number of miles you drive to work?*

Yes

No

Have you created a Trust and placed your home into it?*

Yes

No

Have you created a LLC?*

Yes

No

If yes, what was the purpose of the LLC?

Have you had a significant change in net worth?*

Yes

No

Are you on a board of directors?*

Yes

No

If yes, does it have Directors and Officers coverage?

Yes

No

Is your name on any other deeds (other homes, properties, etc.) by itself or with other names?*

Yes

No

Are you planning to buy any property or have your name added to a deed?*

Changes to your HOME and updates to info we have on file:

Please think back over the last year when answering these questions.

If your drain backed up or sump pump stopped working, and your basement filled with water, what is the value of the contents and building that could be damaged (walls, flooring, furnace, stored items, etc.)?*

0-$5,000

$5,000 - $10,000

$10,000 - $25,000

$25,000 +

Not Sure

Have you or are you planning to renovate your home or property - interior or exterior?*